Iranian Policy Makers Research Articles

Can SMA Innovative Treatments Be Reimbursed? A Rapid Review

Context: Spinal muscular atrophy (SMA) is a rare genetic disorder that significantly impacts the quality of life. This paper aims to gather current understanding of the safety, efficacy, and economic aspects of common SMA treatments to assist Iranian policymakers in adopting these novel treatments for this vulnerable population. Methods: This rapid health technology assessment (HTA) research was conducted in four steps: Database review, screening, data extraction, and thematic analysis. Inclusion criteria consisted of studies focused on assessing the safety, efficacy, and economic aspects of medical interventions in SMA patients compared to those who did not receive such interventions. Results: Based on current data, nusinersen was found to be the most effective treatment (increasing mobility achievements in SMA types 1 and 2) with the least side effects for SMA types 1 and 2. In terms of economic evaluations, none of the treatments were found to be cost-effective. Conclusions: The decision regarding reimbursement for such medical drugs should not focus solely on their cost-effectiveness but rather on creating access to essential care, meeting patient needs, and considering national budget limitations. Managed entry agreements (MEAs) are flexible tools that service providers or payers can use to negotiate and reduce the financial burden for both patients and payers.

Disparity in cognitive factors related to cancer screening uptake based on the theory of planned behavior

IntroductionEarly detection of cancer is a highly effective way to decrease cancer-related deaths. The purpose of this study was to determine the disparity in cognitive factors related to cancer screening uptake based on the theory of planned behavior (TPB).MethodsIn this cross-sectional study, conducted in Kermanshah County, the west of Iran, during 2019, a total of 1760 people aged 30 to 75 years old, were randomly selected to participate voluntarily in the study. Participants filled out a questionnaire including the socio demographic variables, socioeconomic status (SES), TPB variables, and cancer screening uptake behaviors.ResultsThe mean age of respondents was 45.28. 44.96% of the participants had undergone cancer screening at least once. Socioeconomic status (SES) and gender had the most significant impact on the disparity in cancer screening uptake, with contributions of 74.64% and 22.25% respectively. Women were 8.63 times more likely to be screened than men. Participants with a family history of cancer had a 2.84 times higher chance of being screened. Single individuals were significantly less likely to be screened compared to married individuals. The concentration index for attitude, subjective norms (SN), perceived behavior control (PBC), behavior intention, and cancer screening uptake was 0.0735, 0.113, 0.333, 0.067, and 0.132 respectively. Intention (Beta = 0.225 and P: < 0.001) is a significant predictor of cancer screening behaviors.ConclusionThe findings of this study are highly valuable for health policymakers in Iran. They emphasize the significance of creating, executing, and assessing campaigns that promote intention, PBC and SN, particularly among disadvantaged individuals. By doing so, we can effectively decrease the disparity in cancer screening rates. It is crucial to prioritize men, single individuals, and disadvantaged groups in cancer screening promotion programs. This knowledge can be utilized to develop an intervention that is guided by theory and supported by evidence, with the aim of increasing cancer screening rates and minimizing disparities.

Experiences and attitudes of clinical and academic nurses about infection prevention and control nursing curriculum and duties - a qualitative study

BackgroundInfectious diseases are becoming more widespread and re-emerging, causing psychological, social, economic, and health effects at both national and international levels. Specialist nurses can help prevent and control these infections. However, in Iran, there are currently no specialist infection prevention and control (IPC) nurses to manage and control infections. This study aims to explore clinical and academic nurses’ attitudes toward IPC nursing curriculum and duties.MethodsThe study used a qualitative content analysis approach. Thirty-six participants, including clinical and academic nurses, were selected using a purposeful sampling method. Data was collected through seven focused group discussions. The accuracy and validity of the research tools were measured using the Four-Dimension Criteria developed by Lincoln and Guba. Data analysis was conducted using directed content analysis.ResultsThe data analysis of the discussions held in the seven focus groups extracted 628 codes. Three themes were developed from the qualitative analysis: “Core characteristics of the curriculum”, “Expected competencies and skills”, and “Evaluation.” These themes were derived from nine main categories and 25 subcategories.ConclusionsSpecialist IPC nurses can play important roles in various positions and environments. Therefore, educational policymakers in Iran should consider establishing IPC nursing courses. It is also recommended that policymakers and decision-makers in the nursing field of other less developed countries should prioritize this issue.

Family Self-Support in Managing Down Syndrome Children: A Qualitative Study.

Background and Aim. Down syndrome (DS) is the most common reason for disabilities caused by genetic disorders. Due to the special nature of this disease and the special needs of children with Down syndrome, they are required to receive their families' support. Therefore, the recognition of their problems and needs and also the alternatives for resolving them and promoting their life quality are very useful. Also, since very limited qualitative studies have been conducted, it seems necessary to design a qualitative study. Method. This qualitative study was conducted by the content analysis method and through purposeful sampling method with the participation of 26 participants including 15 mothers, 6 fathers, 3 sisters, and 2 brothers of DS children in 2022-2023. The data were collected through semi-structured interviews. Findings. Using the content analysis method of Graneheim and Lundman (2004), the main theme was "Family self-supporting in protecting Down syndrome children." The subthemes were seven including "trying to find information-support resources," "Giving importance to child's health," "religious beliefs of the family," "child moral education, helping to child's relative self-support," "developing familial support," and "developing child's social interactions." Conclusion and Recommendations. The findings of this study showed that family is the main source of fulfilling the needs of children and their life challenges through using efficient self-support methods. This study introduced family self-support methods in terms of DS children in a way that other families can also manage the problems of their children more efficiently. The present study can be used by trustees of DS to support them and their families. Considering the existence of many problems in children with Down syndrome and the involvement of families, it is suggested that policymakers and community health managers provide the basis for receiving services and social support. For example, it is possible to strengthen the screening systems in the country to diagnose the disease on time and take quick action to solve this problem. Also, by increasing the health insurance coverage and fair distribution of the support resources needed by these people, it promoted the quality of life for them and their families. Also, health policymakers in Iran can take action to increase life expectancy and reduce deaths caused by DS by improving the equitable distribution of health resources and services. Also, public policies should enhance supportive intermediation for prevention and life quality promotion and also decrease health challenges. They are also supposed to lessen the costs of health care. Furthermore, to support social organizations, health service providers and researchers should consider the development of intermediations for the health enhancing and life quality promoting of DS children.

Faculty members as academic knowledge brokers in Iran's health sector: a social network analysis study

BackgroundInteraction between researchers and policymakers is an essential factor to facilitate the evidence-informed policymaking. One of the effective ways to establish this relationship and promote evidence-informed policymaking is to employ people or organizations that can play the role of knowledge brokers. This study aims to analyze the communication network and interactions between researchers and policymakers in Iran's health sector and identify key people serving as academic knowledge brokers.MethodsThis study was a survey research. Using a census approach, we administered a sociometric survey to faculty members in the health field in top ten Iranian medical universities to construct academic-policymaker network using social network analysis method. Network maps were generated using UCINET and NetDraw software. We used Indegree Centrality, Outdegree Centrality, and Betweenness Centrality indicators to determine knowledge brokers in the network.ResultsThe drawn network had a total of 188 nodes consisting of 94 university faculty members and 94 policymakers at three national, provincial, and university levels. The network comprised a total of 177 links, with 125 connecting to policymakers and 52 to peers. Of 56 faculty members, we identified four knowledge brokers. Six policymakers were identified as key policymakers in the network, too.ConclusionsIt seems that the flow of knowledge produced by research in the health field in Iran is not accomplished well from the producers of research evidence to the users of knowledge. Therefore, it seems necessary to consider incentive and support mechanisms to strengthen the interaction between researchers and policymakers in Iran's health sector.

Predictors of antiretroviral treatment failure to the first line therapy: a cross-sectional study among Iranian HIV-positive adults

BackgroundHIV virological failure is one of the main problems in HIV-infected patients, and identifying the main predictors of such treatment failure may help in combating HIV/AIDS.MethodologyThis cross-sectional study included 1800 HIV-infected patients with either virological failure or treatment response. HIV viral load, CD4 count, and other tests were performed. Statistical analysis was used to determine the predictors of virological failure.ResultsClinical stage, treatment with reverse transcriptase inhibitors (RTIs), under therapy for three years or more, suboptimal adherence to antiretroviral treatment (ART), age > 40 years, CD4 count < 200 cells/mm3, unemployment, being infected through sex, and the presence of symptoms were the predominant risk factors for virological failure. In addition, 55% of patients who experienced virological failure failed to experience immunological and/or clinical failure.ConclusionAs the first study in southern Iran and the second in Iran, Iranian policymakers should focus on intensive counseling and adherence support and emphasize more effective treatment regimens such as protease and integrase inhibitors (PIs and INTIs), to increase the chance of a treatment response to ART. The accuracy of identifying clinical and immunological criteria in resource-limited settings is not promising. The present findings can be used to determine effective measures to control HIV treatment failure and design efficient strategies for the ambitious 95–95–95 plan.

Tracing water resources flows by complementary use of hydrological and water accounting models

AbstractHistorically, there has been a dispute over water allocation between users and policymakers in Iran's Zayandeh‐Roud Basin (ZRB). In this study, we used the “System of Environmental‐Economic Accounting for Water” (SEEAW) framework in combination with the hydrologic model “Soil and Water Assessment Tool” (SWAT) to achieve the water balance in ZRB. We used SEEAW to combine a wide range of water‐related statistics across stakeholders and SWAT to evaluate the unknown agricultural water use. The SWAT model is calibrated based on the stream flows and crop yields in the basin. The model assess the renewable water of the basin into two components, about 363 and 70 mm as green and blue water, respectively. Also results from the physical water supply and water use tables demonstrates that the agricultural sector uses 78% of the total renewable freshwater, followed by the residential, 16%, and the industrial sector, 6%. The flows of water from source to services in ZRB are traced based on the water supply and water use tables. The flow diagram shows that 8 MCM of industrial reused water was transferred to the agricultural sector, and 137 MCM and 18 MCM of water from the wastewater treatment plants to the agricultural and industrial sectors, respectively. Furthermore, the results show that the index of the basin dependence on groundwater resources is high (61%), the value of water stress is high (0.88) and the dependence of the basin on transboundary water resources is 30%. Therefore, this method is highly beneficial for achieving a conceptual water balance in disputed basins without enough agricultural water uses data.

Entrepreneurship development in photovoltaic technological innovation system: a case study in Iran

Purpose This paper aims to develop a causal feedback structure that explains the dynamics of entrepreneurship development in Iran’s photovoltaic (PV) technological innovation system (TIS) to design effective policy interventions for fostering PV innovation. Design/methodology/approach This study adopts the system dynamics approach to develop the causal structure model. The methodology follows a systematic method to elicit the causal structure from qualitative data gathered by interviewing several stakeholders with extensive knowledge about different aspects of Iran’s PV TIS. Findings Lack of technological knowledge and financial resources within Iranian PV panel-producing firms are the main barriers to entrepreneurship development in Iran’s PV TIS. This study proposes two policy enforcement mechanisms to tackle these problems. The proposed feedback mechanisms contribute to the domestic PV market size and knowledge transfer from public research organizations to the PV industry. Practical implications The proposed policy mechanisms aid Iranian policymakers in designing effective policy interventions stimulating innovation in Iran’s PV industry. Originality/value The main contributions of this study include conceptualizing the causal structure capturing entrepreneurship dynamics in emerging PV TIS and proposing policy mechanisms fostering entrepreneurship and innovation in PV sectors.

Relationship of Health Literacy With Knowledge, Attitude and Practice Regarding the Preventive Behaviors Against COVID-19 in Women in Zahedan, Southeast Iran

Background &amp; Aims With the emergence of COVID-19, health literacy became more important for its prevention. Health literacy is important for attaining positive health outcomes in women. This study aims to investigate the relationship between health literacy and knowledge, attitude and practice regarding preventive behaviors against COVID-19 in women referring to comprehensive health service centers in Zahedan, Iran. Materials &amp; Methods This descriptive-correlational study with a cross-sectional design was conducted on 144 women aged 18-60 years referred to comprehensive health centers in Zahedan, Iran, from September to December 2022. The sampling was done using a multi-stage stratified sampling method based on the entry criteria. To collect data, a sociodemographic form, the knowledge, attitude, practice questionnaire for preventive behaviors against COVID-19, and Savci et al.’s health literacy scale for protection against COVID-19 were used. Data were analyzed using Pearson correlation test, independent t-test, one-way ANOVA and regression analysis in SPSS software, version 23. Results The mean age of women was 31.74±10.02 years. Most of them had middle school education (64.4%) and were married (90.3%), with a monthly income level of 6-10 million Iranian Tomans (29.9%). Most of them were willing to receive COVID-19 vaccine (81.9%). Only 28.7% had a history of hospitalization due to COVID-19 infection. Their mean scores of knowledge, attitude, and practice were 14.9±2.93, 42.9±6.69, and 32±6.1, respectively. Their mean health literacy score was 39.5±11.08. Educational level, monthly income level, and history of receiving COVID-19 vaccine explained 48% of the variance in health literacy in the first-order regression model, and 61% of the variance in the second-order regression model. Conclusion The increase in health literacy, can improve knowledge, attitude and practice of women regarding preventive behaviors against COVID-19. In addition, their health literacy for preventive behaviors against COVID-19 is related to their age and education level. It is recommended to use educational programs to increase health literacy for emerging diseases in women from southern Iran. The results of this study can help policy makers in Iran developing health promotion interventions.

COVID-19-Related Anxiety and Its Relationship With Job Burnout in Health Workers From Bushehr Province, Southern Iran

Background &amp; Aims Health workers during the COVID-19 pandemic had high responsibilities of prevention and treatment, which can cause anxiety in them considering the negative effects of the pandemic on mental health. This study aims to investigate the COVID-19-related anxiety level and its relationship with job burnout in health workers from Bushehr province, southern Iran. Materials &amp; Methods This is a descriptive-correlational study with a cross-sectional design that was conducted in 2022. Participants were 365 health workers from health centers affiliated to Bushehr University of Medical Sciences, who were selected by census method. The data was collected using a sociodemographic form, the Maslach Burnout Inventory, and the corona virus anxiety scale. SPSS software, version 16 was used for data analysis. Results Of 365 health workers, 308 completed the questionnaires. The majority of thm were female (69.5%) and married (85.7%). Their mean age and work experience were 37.8 and 13.9 years, respectively. The anxiety in most health workers (70.8%) was mild (Mean: 12.58 ±10.81). The findings also showed that 31.8% had moderate to severe emotional exhaustion; depersonalization was mostly low (82.1%), and about half had low personal achievement (49.7%). There was a significant relationship between COVID-19-related anxiety and emotional exhaustion (r=0.667; P&lt;0.001), depersonalization (r=0.472, P&lt;0.001), and personal achievement (r=-0.188, P=0.001). Conclusion There is a significant relationship between anxiety caused by COVID-19 and job burnout in health workers. Although the pandemic did not cause high anxiety among health workers in Bushehr province, it can disrupt their performance. Policymakers in Iran should pay more attention to the negative effects of pandemics on health workers.

Examining the Role of Scientific Authority of Sports Management Journals in the Sports Policy-Making Process: Impact Analysis and Strategies

The objective of this study is to examine the role of the scientific authority of sports management journals in the sports policy-making process in Iran. The study aims to identify the impact of reputable academic journals on sports policy, the challenges and obstacles in the communication between these journals and policymakers, and to propose strategies to improve the policy-making process. This research was conducted using a descriptive-analytical approach with a literature review methodology. Data were collected through the examination of credible scientific sources, articles published in national and international journals, and analysis of related research findings. The study aimed to explore the role of scientific authority in sports policy-making in Iran by analyzing content and reviewing relevant literature. The findings indicate that reputable scientific journals can significantly influence sports policy-making. However, in Iran, several barriers, including ineffective communication between scientific journals and policymakers, cultural and managerial obstacles, and insufficient use of scientific knowledge in policy formulation, have reduced the impact of these journals. The results also show that strengthening the interaction between universities and governmental bodies, developing scientific networks, and enhancing international collaborations can help improve the sports policy-making process in Iran. The scientific authority of sports management journals plays a crucial role in enhancing the quality and efficiency of sports policy-making in Iran. However, to better utilize these academic resources, existing barriers must be addressed, and communication between researchers and policymakers must be strengthened. It is recommended that further research be conducted on the challenges of sports policy-making in Iran to provide suitable strategies for improving these processes.

A Dynamic Model for Analyzing Investment Policies in Iran's Oil Production and Its Scenarios

various related scenarios. The study aims to identify and assess different financial and investment policies that could enhance investment attraction in Iran's oil industry. Methodology: The study employs system dynamics and content analysis to develop the model. The statistical population for the content analysis includes upstream oil industry documents and related articles on investment. In the quantitative section, employees, managers, and experts in the oil industry were selected as the sample population. Data analysis was conducted using Vensim software, and nine different scenarios were developed to evaluate financial and investment policies. Findings: The results revealed that intermediary financing, with an increase of 128.854 units, was identified as the most attractive policy. Debt-based financing, with an increase of 108.333 units, and financing based on underground reserves, with an increase of 69.580 units, followed. These findings highlight the importance of diversifying financial resources and utilizing innovative financial structures in Iran's oil industry. Conclusion: The study concludes that a combination of different financial resources and the application of diversified financial policies can significantly contribute to attracting more investments and reducing financial risks in Iran's oil industry. These findings align with previous studies on financial and investment policies and provide valuable insights for policymakers in Iran's oil sector.

Energy security and sustainable development from the standpoint of energy paradigm of Iran

After 1970’s energy crisis and west world’s oil shock policy makers especially from demand-side countries, follow a new approach to set national energy strategies. Energy security emerged as a systematic respond to the global crisis and is aimed to improve energy systems resilience level. The high correlation between economic indicators, as GDP and energy consumption, especially for energy export countries, allows considering energy security as a long-term respond to support sustainable development. In this paper we aimed to investigate energy security as a key concept and discuss how it is tied to the sustainable development. The research method is the literature and document review. As it has been shown, energy security is a complicated concept needed to be localized to address local challenges of certain country. Hence, it is crucial for Iran to study energy security from a new angle to adopt more sustainable energy policies. It is expected that in a near future, energy security will become a challenging issue for Iranian policy makers.

Non-financial access to healthcare services in rural areas: A case study of people with disabilities living in Northern Iran

Introduction Access to healthcare for persons with disabilities (PWDs) is an important but often ignored issue for achieving universal health coverage. The current study aimed to investigate PWDs’ access to healthcare in the rural areas in north of Iran. Methods Following a descriptive-analytical design, 471 persons with disabilities (PWDs) living in the Nor city, Mazandaran province, were selected using quota sampling. Data were collected by a valid and reliable questionnaire that contained dimensions of time, geography, physical, and acceptability using face-to-face interviews. The findings are provided by central and dispersion indicators and analyses are performed with linear Regression using SPSS version 17. Results PWDs had moderate access to healthcare services in all dimensions. The regression models for access to health services in all four dimensions were significant (p&lt;0.05). The results showed that in the geographical dimension, the variables of marital status, income, receipt of financial aid, supplementary insurance, and type of disability; in the physical dimension, the variables of income, responsibility for taking care of the family, supplementary insurance, and type of disability; in the time dimension, supplementary insurance, home area, and type of disability; and in the aspect of service acceptability, only the variables of type of disability and internet access had a significant effect (p&lt;0.05). Conclusion A small percentage of PWDs had high access to health services. Hence, improving their access to healthcare services, particularly in rural and less developed areas, and developing appropriate policies should be the focus of Iranian policy-makers.

The preferred IT sources and tools of Iranian people for accessing health information

IntroductionPeople need health information to maintain their health. Despite the variety of sources and tools for providing health information, there is little evidence about Iranian people's preferences in using these sources and tools. The objective of this study was to identify the preferred health information sources, tools, and methods for presenting health information in these tools.MethodsThis national survey was conducted among a sample of 4000 Iranian people between April and September 2021. The data was collected using a valid and reliable questionnaire (α = 0.86) consisting of four sections: participants' demographic information, current sources of obtaining health information, preferred information technology (IT) tools for accessing health information, and the method of presenting this information. Linear regression was used to investigate the relationship between demographic factors and other questions.ResultsThe participants received health information mostly from the "Internet" (3.62), "family or friends" (3.43), "social networks" (3.41), "specific websites" (3.41), and "mobile apps" (3.27). "Social networks" (3.67), Internet "websites" (3.56), and "mobile apps" (3.50) were the most suitable tools for receiving health information. The participants preferred the presentation of health information in the form of "Images" (3.85), "educational videos" (3.69), and "texts" (3.53). Age, education, and marital status had a significant relationship with most of the preferred information sources, tools, and information presentation methods (p < 0.05).ConclusionThe results of this study showed that Iranian people are more active information seekers than passive ones compared to a decade ago. The preferred sources and tools identified in this research can be used by healthcare planners and policy-makers in Iran and other developing countries to design and develop IT interventions that meet people's needs. Improving access to the Internet, social networks, and mobile apps and providing health information via images, educational videos, and texts on these platforms enhance access to the information people need.

Identifying the Contextual Factors Affecting the Policymaking of Physical Activity in Iran: A Qualitative Study

Background. The reduced level of physical activity is a current global concern. To address this concern, encouraging physical activity should be highlighted by public health policymakers of the countries. This study aimed to identify the factors affecting the policies on physical activity in Iran. Methods. In this qualitative study, the analytical framework was adopted to interview 23 key informants selected by the targeted sampling with maximum variation from October 2020 to February 2021. The semi-structured interviews were performed and analyzed until the data saturation was achieved. MAXQDA-10 software was used for data management. Results. Different factors including managerial-structural, socio-cultural, political (i.e., policymaking, legal, and international), and situational factors (i.e., perceived environmental factors, changes in people's lifestyle, and restrictions caused by COVID-19) were the main contextual factors affecting the policymaking process. Conclusion. It was concluded that several relevant factors affected the policymaking in Iran regarding the physical activity. Therefore, it was recommended that these contributory factors should be considered by policymakers when making policies on physical activities.

National and Subnational Trend of Dental Caries of Permanent Teeth in Iran, 1990–2017

ObjectiveThere are currently no integrated data on the trend of dental caries amongst distinct age groups in Iran. We aimed to assess the national and subnational trend of dental caries of permanent teeth in Iran from 1990 to 2017. MethodsA literature search about dental caries and the decayed-missing-filled teeth index (DMFT) was performed in PubMed, Web of Science, Scopus, and 3 national databases (in Persian). All eligible national oral health surveys in these 28 years were included. We categorised and aggregated the DMFT values and their components based on age (5-year-based groups from 5 to 9 to 60+ years), sex, year, and province. The data for missing spots were estimated using the spatiotemporal Bayesian hierarchical model. We used the bootstrap method in multilevel models to predict the uncertainty interval (UI) of the modelled results. ResultsNationally, the all-ages mean DMFT increased by nearly 58.0% (6.8 [95% UI, 4.1–10.5] in 1990 to 10.8 [95% UI, 7.5–14.5] in 2017). Decayed teeth (DT) and missing teeth (MT) rose by 84.5% and 31.6% during this period, respectively. Filled teeth (FT) showed almost a 2.6-fold increase in the same period from 0.6 (95% UI, 0.01–1.6) in 1990 to 1.7 (95% UI, 0.6–2.8) in 2017. The proportion of DT and FT continuously increased in both sexes. In 2017, the highest DT, MT, and FT were estimated in the 25–29 (4.9 [95% UI, 2.5–7.2]), 60+ (21.5 [95% UI, 17.5–25.4]), and 35–39 (2.6 [95% UI, 1.3–4.0]) year age groups. ConclusionsCaries of permanent dentition levies a growing burden on the Iranian population. Considering the continuous increase in caries during the 1990–2017 period, Iranian policymakers should pay heed to these findings and react more proactively to mitigate this perpetuating issue. Implementing nationwide interventions such as sugar consumption management should be encouraged to achieve sustainable outcomes in this regards.

Spatiotemporal clustering of suicide attempt in Kermanshah, West-Iran.

A suicide attempt is a major societal problem because it imposes high costs on societies worldwide. This paper analyses the spatiotemporal clustering of suicide attempt in Kermanshah, Iran from 2006-14. This study draws on 18,333 individuals (7,234 males and 11,097 females) who attempted suicide across the Kermanshah province. Data was collected from the records of individuals registered in hospitals across the Kermanshah province between 2006 and 2014. Mean Center, Standard Deviational Ellipse (SDE), Moran's I and Kernel Density Estimation (KDE) in Arc/GIS10.6 software were used for the analysis of the spatial distribution of suicide attempt, while the chi-squared test in SPSS was used to examine the different demographic variables between groups within/outside spatial clusters of suicide. The results show that a total of 18,331 suicide attempts (39.46% male and 60.53% female) were reported between 2006 and 2014 in the Kermanshah province. The spatial pattern of suicide attempts was clustered in 16 clusters (6 high clusters and 10 low clusters) and statistically significant differences were found within and outside the hotspots of suicide attempts. Most hot spots were formed in and around cities. Younger people were at a greater risk. The rate of suicide attempts reduced in illiterate people and increased in people with university degrees. Unmarried people were associated with a higher risk of suicide attempt than was married status for both males and females. The results of this study could help public health practitioners and policymakers in Iran prioritize resources and target efforts for suicide attempt prevention.

Exploring senior managers’ experiences preparedness to respond to COVID-19: a qualitative study in Iran

BackgroundEpidemics caused by emerging respiratory viruses are challenging for the health system of most societies, and preparedness of the health system in responding to such epidemics is important. Therefore, the aim of this study was identifying different fields and key issues of the senior managers’ experiences preparedness to respond to the COVID-19 epidemic from the Iranian senior managers’ point of view.MethodsThis is a qualitative descriptive study. Eighteen in-depth and semi-structured individual interviews were conducted for data collection. For this purpose, 18 senior managers with work experience in managing the COVID-19 crisis were enrolled in the study using purposive sampling. The collected data were analyzed according to Graneheim and Lundman’s approach.ResultsAnalysis of the data resulted in the emergence of five themes and twelve sub-themes. The main themes and sub-themes included: (1) capacity improvement consisting of performance improvement and logistic improvement; (2) resource and infrastructure management including supply and support of human resources, infrastructure improvement, and supply of equipment; (3) an increase in epidemiology capacity including epidemiology improvement and emerging disease surveillance; (4) application of the principles of disaster and emergency management including intra- and extra-organizational interaction management, disaster risk management, and data management; and (5) society resilience increase including improving adaptation skill and maintaining health and social participation.ConclusionThe results of this study present the key issues for the management of future emergency situations. Health system managers and policymakers in Iran and other countries should be aware of these key issues and apply them in practice to prepare the health systems to respond to next outbreaks. Indeed, the study results can help policymakers and health system managers to plan to achieve acceptable preparedness for the management of such outbreaks.

‘The perspectives of Iranian Feminists and Women Activists on Gender Equality in Iran’

ABSTRACT This paper explores the perspectives of Iranian women involved in women’s activism and policymaking in Iran on gender equality and gender justice. The study draws on 47 in-depth semi-structured interviews through an explanatory approach. Participants in this study included women’s activists, whose points of reference is the Islamic teaching, as well as those women activists who consider women’s rights outside the framework of religion. The Iranian political leaders do not accept equality between men and women, and their gendered policies have limited the activities of feminists and women activists. Key findings demonstrate that participants take different positions in the conceptualization of gender equality and gender justice and that there is a strong link between women’s political and social position, self-identification and the terminology they use to advocate for women’s autonomy and calling for change.